Reimbursement

By the WoundSource Editors

When determining the course of action for treating a given wound, it is important that wound care clinicians evaluate how advanced wound care therapies have been deemed evidence based and how the specific product technology works. Evidence-based advanced wound care products are required to be safe and effective based on epidemiology, etiology, and pathophysiology. However, safety and efficiency are not a 100% guarantee of effectiveness in clinical practice.

By the WoundSource Editors

Wound chronicity is an ongoing challenge for patients and health care professionals around the globe. An astonishing 4.5 million people in the United States experience lower extremity wound chronicity, while an estimated 1% are affected in the Western population with all types of chronic wounds. The cascade of wound healing does not always follow suit in an orderly fashion of hemostasis, inflammation, proliferation, and remodeling.

Becky Naughton, RN, MSN, FNP-C, WCC

What if I told you that there is a substance that we can isolate from your own blood that can help to heal the most difficult wound? I envision a scene out of "Star Trek" where Bones does a quick scan of his patient, draws some blood, runs it through some machines, and then out pops a seemingly magical elixir. He studies this new yellow substance and then injects it back into his patient (with a quick and seemingly painless puff from his high-tech injector gun).

By Lydia Corum RN MSN CWCN

The times are changing in the world of wound care. There used to be a time when there were no problems with reimbursements, as long as the doctor wrote the order. Today, the Centers for Medicare & Medicaid Services (CMS) regulations confuse clinicians and make the world of healing wounds much more difficult. The changes are in the area of denials with not enough information given for choosing dressings, use of negative pressure therapy and hyperbaric oxygen therapy. Are all these changes needed? Why are these changes happening? What can hospitals and wound clinics do to make things better?

By Cathy Wogamon, DNP, MSN, FNP-BC, CWON, CFCN

Wound care has evolved into a massive specialty service in the past few decades, with new treatment modalities, advances in care, and thousands of wound care products. On the forefront of advancements in technology and wound care is a new way to provide care to the patient: telehealth.

by the WoundSource Editors

Dressing selections can be overwhelming for clinicians and providers in health care. There are now well over 6,000 wound care products on the market. Ideally, there would be a multifunctional smart dressing that could “do it all” readily available in all settings. Unfortunately, we as health care providers know, that definitely isn’t the case.

By The Alliance of Wound Care Stakeholders

The Alliance of Wound Care Stakeholders Alliance of Wound Care Stakeholders (Alliance) played a key role in educating the Food and Drug Administration (FDA) and its advisory panel on the role and real-world value of antimicrobial wound care dressings, as the FDA considered a regulatory classification of these products that could impact access and availability to wound care providers and patients.

By Thomas E. Serena MD, FACS, FACHM, FAPWCA

Fans of folk singer John Prine will recognize the homey lyrics describing his views on organ donation. Sitting at my desk a few weeks ago with John Prine twanging in my headphones, I began to slog through the new Noridan Local Coverage Determination (LCD) on hyperbaric oxygen therapy (HBOT). It should not have come as a surprise that the Centers for Medicare & Medicaid Services (CMS) is planning prepayment review for HBOT services. We have been struggling for months in New Jersey, Michigan and Illinois with preauthorization. What is frightening is that a large number of the denials we have seen are completely nonsensical, bureaucratically driven, and dangerous: a patient with osteoradionecrosis of the jaw, for example, was denied because she didn't have 30 days of standard of care; or perhaps the CMS keyword search engine selected out a proscribed adjective!

By The Alliance of Wound Care Stakeholders

The Alliance of Wound Care Stakeholders' (Alliance) quarterly update provides an overview of ongoing advocacy initiatives to ensure access, coverage and payment to wound care procedures and technologies for patients. This update includes current action items, updates on key areas of focus from the past quarter, and future issues for the second half of 2016 that the Alliance is tracking that are of importance to the wound care community, including clinicians who may be impacted by policy changes.

By Mary Ellen Posthauer RDN, CD, LD, FAND

The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT) amends Title XVIII of the Social Security Act by adding a new section –Standardized Post-Acute Care (PAC) Assessment Data for Quality, Payment, and Discharge Planning. The goal of the IMPACT Act is to reform PAC payments and reimbursement while ensuring continued beneficiary access to the most appropriate setting of care. The act requires the submission of standardized and interoperable PAC assessment and quality measurement data by Long-Term Care Hospitals (LTCH), Skilled Nursing Facilities (SNF), Home Health Agencies (HHA) and Inpatient Rehabilitation Facilities (IRF).